MODULE 1

What is Massage Therapist

The massage therapist will be the one conducting the therapy session to the
respective clientele/patient. Due to the extensiveness of massage therapy as a practice, the
massage therapist should be trained and be knowledgeable to a certain degree.

Job Opportunities
As massage therapy is rising in popularity, there are numerous places where you
may find work, such as:

 Massage franchises
 Fitness clubs and gyms
 Physical therapy offices
 Chiropractors’ offices
 Hospitals, nursing homes, extended care facilities
 Hotels
 Luxury resorts and spas
 Shopping malls
 Private practice
 Advantages and Disadvantages
Advantages of being a massage therapist:
 Schedule - As a massage therapy practitioner, you have the flexibility with the hours
you are available to work.

 Mobility - Due to the flexibility of the practice, you are free to work in any specific
area.

 Money - A job in this industry can be a very lucrative one. The money you can
potentially earn depends on a number of factors. As a masseuse, you also have the
opportunity to earn tips. As your experience and reputation go up, so too will your earnings.

Disadvantages of being a massage therapist:

 Long hours standing - This job is one that can be physically taxing on your body. As
such, it is not hard to get burned out. If you're constantly seeing patients and performing
services, without taking breaks, you're more prone to injury.

 Money - The money you earn as a licensed masseuse can also be a disadvantage.
This business is client-based which means your pay is directly affected by the number of
clients you see. Less clients means less money. To prepare for when you're not bringing in
as much money, you'll want to make sure you're good at budgeting and saving.

 Unrealistic client expectations - Some of your clients may expect for you to
completely rid them of their pain and discomfort. Given that this is an unrealistic
expectation, massage therapists can be negatively affected as this can result in dissatisfied
clients. It will be your duty to correct the clients beliefs so as to not have them expecting
permanent healing.

Challenges
Most people are eligible for the relaxation and health benefits of massage therapy.
However, there are times when a massage may not be the right choice. Certain conditions
contraindicate massage, either because of the risk it may pose to the client or the risk to the
therapist.

Infections
Since massage is based on skin-to-skin touch, massage may also be contraindicated
if the client has a rash or infectious skin condition. If the skin condition is infectious, it could
spread to the therapist and, in turn, to other clients. Even if a skin condition is not contagious,
massage can make some skin irritations even worse.
 Intoxicated Patient
Another occasion when a massage should be postponed is if the client is intoxicated.
Many folks seek out massage while on vacation or under stress. They may have also had a
few cocktails to relax as well. "Intoxication is a risk during massage," said Dr. Coe, "primarily
because it desensitizes the client. This makes it hard for the client to give reliable feedback. A
massage therapist needs to know what level of pressure is comfortable and what is too much.
With intoxication, those sensations are unreliable."

Challenging Behavior of Clients

The first step in keeping your cool when a client proves to be a challenge, is to own
your contribution to the problem. As outlined by the universally understood Law of Attraction,
like begets like. When viewed within the framework of a difficult client, this translates to a
therapist’s own negativity has the potential to bring people into their practice with energy to
match.

Whether a therapist believes that he or she has or has not contributed to attracting or
perceiving a challenging personality into his or her practice, there are several steps to make
the session more pleasant. Depending on the situation, the following suggestions may or may
not be appropriate:

 Seek Positive Traits – Look for a great quality in your client and focus on that.
 De-stress – Release any stress you may be holding before seeing clients to clear
away your negative energy.
 Create Boundaries – If your client pushes limits or is disrespectful, assertively define
appropriate behavior within your practice.
 Refer Out – If the stress associated with a specific client cannot be overcome,
remember your prerogative to refer elsewhere.
Code of Ethics for Massage Therapists
Ethics and professionalism are the corner stones for a successful massage practice.
The massage therapy profession follows a set of guiding principle based on the right and
wrong. The fundamental ethical principle for massage therapy is client – centered care, which
focus on the attitudes, decisions and activities on whatever is best for the client’s health and
well being.

General Responsibilities
The services rendered by Massage Therapists are universal and unrestricted by
considerations of nationality, race, creed, color, politics or social status. The professional
relationship of Massage Therapists towards various industry stakeholders are characterized
as follows:

Duties toward the client – The client’s health and wellbeing are the paramount of
the Massage Therapists.

Duties toward the profession – The Massage Therapist shall strive for excellence
and advance the moral reputation of the profession by conducting himself/herself with honor
and dignity.

Duties toward co-practitioners – The Massage Therapist shall foster fellowship,

mutual assistance, and professional respect among co-practitioners.

Duties toward employers – The Massage Therapist shall be fair, honest, and loyal
in dealings with employers.

Duties toward allied professionals – The Massage Therapist shall respect the
dignity, competence, and the scope of services of allied professionals, working harmoniously
with them for the good of the community.

Duties toward the general public – The Massage Therapist shall obey the laws of
the land and all laws governing the practice of the profession, as enforced by the duly
constituted authority.

* For more information about the code of ethics for Massage Therapists (CEMT
Resolution No. 2010-001), visit the Department of Health website (www.doh.gov.ph)
 MODULE 2

Basic Anatomy and Physiology

Knowledge on anatomy and physiology is important to be an effective massage
therapist. As the massage therapist begins to study anatomy and physiology, the massage
therapist becomes more aware and conscious in implementing massage plan that will benefit
the client.

Anatmomy is the branch of science concerned with the bodily structure of humans,
animals, and other living organisms, especially as revealed by dissection and the separation
of parts.

Physiology is the branch of biology that deals with the normal functions of living
organisms and their parts.

Body Regions
The human body is bilaterally symmetrical. It has the right and left halves. Most of the
body parts are found in pairs, one in each half of the body.

1. Head and Neck - The head contains the core elements of the nervous system. The
head is held upright by the muscles and bones of the neck.

2. Trunk - The trunk or torso is the main part of the body, to which the head and limbs
are attached. The trunk has two sections: the thorax (upper part) and the abdomen (lower
part)

3. Upper Extremities - The upper extremities is divided into three regions: the arm,
forearm and hand.

4. Lower Extremities - The human leg is the entire lower extremity or limb of the
human body, including the foot and thigh.
 Body Positions
Before clients get on the massage table, the massage therapist must be familiar with
the different body positions that the clients can use.

1. Supine - a position where the client is lying on the back, or spine with face up. When
the clients are in supine position the massage therapist has access to the anterior surface
of their body.

2. Prone - a position where the client is lying face down on the massage table. When
the clients are in this position the massage therapist has unrestricted access to the client's
back.

3. Side Lying - a position of the body lying on one side, usually with the knees slightly
flexed.
 Skeletal System
The Skeletal system is all of the bones in the body and the tissues such as tendons,
ligaments and cartilage that connect them. The skeleton gives the body its basic framework,
providing structure, protection, and movement.

The cartilage is a flexible connective tissue that links the ribs to the sternum, forms
the framework of the ear and nose, and covers the ends of bones inside the joints. Ligaments
are strong strips of fibrous connective tissue that hold bones together at joints, thereby
stabilizing the skeleton during movement.

Major bones and bone groups of the body

 Bones of the Head

o Skull – This is the cranium, the bony framework of the head composed of the
cranial and facial bones plus the maxilla and mandible (upper and lower jaws). The skull
houses and protects the brain.

 Vertebral column

oVertebrae – are any of the 33 bones of the vertebral column, comprising of 7 cervical, 12
thoracic, 5 lumbar, sacral, and coccygeal vertebrae. The sacral and coccygeal vertebrae
are fused into single units. The spinal cord passes through and is protected by the
vertebrae.

 Thoracic Cage

oRibs – Twelve pairs of narrow curved bones that extend from the vertebrae to the sternum.
The upper seven enclose the thoracic or chest cavity and protect the heart and lungs. The
lower five enclose part of the abdominal cavity.

oSternum – It is found on the midline of the anterior chest wall. It extends from the throat down
to the upper abdominal area. The anterior end of each rib is attached to the sternum.

 Pectoral Girdle

oClavicle – This is the elongated, slender curved bones of the anterior shoulder known as
collarbone. It extends laterally from the top of the sternum to the scapula. The connection
 of the sternum and the clavicle is an important landmark in locating the internal carotid
artery.

oScapula – The shoulder blade provides for attachment of the clavicle (collar bone) and the
humerus (upper arm bone). The blade portion extends downward over the dorsal surface of
the rib cage.

oHumerus – This is the long bone of the upper arm.

 Upper Extremities

oRadius – The shorter and the lateral two bones of the forearm. It attaches on the thumb side
of the wrist.

oUlna – The medical and longer bone of the forearm. It attaches on the little finger side of the
wrist.

oCarpals – are bones found in the hand. They are also called wrist bones as they are in the
wrist.

oMetacarpalis – The five long bones of the hand. They are slightly concave on the palmar
surface.

 Pelvic

oPelvic Girdle – Three pairs of bones: the ilium, ischium and pubis, fuse to form the pelvic
girdle. It attaches to the lower spine, provides support to the internal organs and has
sockets where the upper legs bones (femur) are attached.

 Lower Extremities

oFemur – The longest, strongest, and heaviest bone of the body located in the thigh area.

oFibula – The lateral and smaller two bones of the lower leg.

oPatella – The kneecap

oTibia – The medical and larger two bones of the lower leg.

oTarsals – The bones in the ankle.

oMetatarsals – The five long bones of the foot that are concave on the plantar or the lower
surface.

oPhalanges – The bones of the toes and fingers.

 Muscular System
The muscular system is the series of muscles throughout the body that moves the
skeleton, maintains posture through steady contraction, and generates heat through cell
metabolism.

Types of Muscle
 Skeletal Muscle- These are voluntary muscles that are attached to the bones of the
skeletons.

 Smooth muscle – These are involuntary muscles that are found in hollow organs like
small intestines and blood vessels.

 Cardiac muscle – Is a type of involuntary muscle that can be found in the heart.

Skeletal Muscle Distribution with Corresponding Contents

 Upper Extremities

oArm – deltoid, biceps, triceps

oForearm – brachioradialis, pronator, supinator

oFingers – thenar muscles, hypothenar

 Lower extremities

o Upper leg – rectus femoris, quadriceps, hamstrings

o Lower leg – gastrocnemius muscle, tibialis anterior

o Upper back – trapezius, erectors spinae

o Lower back – gluteals (buttocks)

 Integumentary System
The skin is the largest organ of the body. As a physical barrier, skin stops water from
leaking out of or into tissues; prevents the entry of bacteria and other disease-causing
microorganisms, filters out the harmful and potentially carcinogenic ultraviolet (UV) radiation
in sunlight; repairs itself if cut or torn. Skin also helps maintain the body’s temperature at a
constant 37 oC (98.6 oF); and contains a range of sensory receptors.

Skin layers and components

 Epidermis – It is the upper layer of the skin. It consists of keratin and melanin.

 Dermis – It is the lower, thicker part of the skin. It consists of blood vessels, sensory
nerve endings and receptors, sebaceous glands, adipose cells, and tiny veins and arteries
 Circulatory System
The circulatory or cardiovascular system consists of the blood vessels and the blood
that is pumped along them by the heart. It plays a vital role in maintaining homeostasis by
controlling the concentration and composition of tissue fluid, by supplying cells with essential
materials and moving their wastes, by helping to keep the body warm, and by protecting the
body against attack by pathogens.

Circulatory system organs, structure and functions

 Blood

o Red blood cells – transport oxygen through hemoglobin.

o White blood cells – antibodies that deals with foreign materials like disease
organisms.

o Platelets – blood clotting.

o Plasma and plasma proteins – carries foods and wastes from tissues.

 Blood vessels

oArteries – carries blood away from the heart.

oCapillaries – exchange of materials between blood and tissue cells.

oVeins – carries blood towards the heart.

 Heart

oArch of the aorta – carries oxygenated blood to the rest of the body.

oAbdominal aorta and thoracic aorta – supplies blood to the abdominal and thoracic area.

oInferior and superior vena cava – carries deoxygenated blood from the rest of the body
 Digestive System
The digestive system is responsible for digestion and absorption of food and water
and for the elimination of solid wastes. Food contains nutrients essential for normal cell
function, growth and repair, therefore to keep the body alive. Digestion is the breaking down
of complex nutrients into simple substances that can be absorbed by the body.

Digestive system division and fuctions.

 Alimentary Canal

o Mouth – Used in chewing and breaking down of food.

o Pharynx – Swallowing mechanism of food.

o Esophagus – It serves as a passage of food.

o Stomach – It is where digestion takes place.

o Small intestine – It is where absorption takes place.

o Large intestine – It is where food is further processed and ends up as feces.

o Anus – It serves as exit of waste products.

 Accessory Digestive Organs

oLiver – It detoxifies drugs and alcohol.

oGall bladder – It serves as reservoir of bile.

oPancreas – It produces the digestive enzyme.

 Urinary System
The two kidneys play a vital role in homeostasis by processing the blood to produce
a waste fluid about 1 ml per minute called urine that is expelled from the body.

Functions of the kidneys

 Excretion of unwanted and potentially poisonous metabolic wastes produced by cells.

 Regulation or removal of excess water and salts (such as sodium and potassium
salts) in order to maintain constant levels of water and salts in the blood and other body
fluids.

Urinary system organs and functions

 Kidney – site of urine production.
 Ureter – connects kidney to urinary bladder.
 Urinary bladder- serves as storage of urine.
 Urethra – passage through which urine is discharged outside the body.
 Respiratory System
The respiratory system takes air into the body and supply the blood with oxygen in
order for the blood to deliver oxygen to all parts of the body.

Respiration is achieved through the mouth, nose, trachea, lungs, and diaphragm.
Oxygen enters the respiratory system through the mouth and the nose. The oxygen then
passes through the larynx and the trachea which is a tube that enters the chest cavity.

Respiratory system structure, organ and functions

 Upper Respiratory tract

o Nose – where air passes and organ of smell.

o Pharyx – serves both digestive and respiratory system.

 Lower respiratory tract

oTrachea – wind pipe; transport air to and from lungs.

oBronchi, bronchioles – where the air entering the lungs are sent to each lung.

oLung – transport air to alveoli for gas exchange.

 Accessory

oDiaphragm – muscular partition that separates abdominal and thoracic cavities.

Physiology of Respiration
 Inspiration (inhalation) – the process of taking air into the lungs.

 Expiration (exhalation) – the process of letting air out of the lungs.

 Nervous System
The nervous system is the major controlling , regulatory, and communicating system
in the body. It receives information from both outside and inside the body, gathered by
sensors such as the eyes and proprioceptors then sends out instruction to effectors such as
muscles and glands to make the body react. It enables a person to think, create, remember,
and feel. It is also responsible for regulation of internal events such as heart rate and body
temperature.

Two main parts of the Nervous system

 Central nervous system (CNS)

o Brain

o Spinal cord

 Peripheral Nervous system (PNS)

oSomatic System

oAutonomic system
 Endocrine System
The endocrine system releases chemicals known as hormones that are carried by
the blood and regulate metabolic activities of cells thereby controlling processes such as
growth, metabolism, and reproduction.

Endocrine system organs and functions

 Pituitary gland – It is the master gland that regulates metabolism, growth, sexual
development and immune response.

 Thyroid gland – Influences the rate of body metabolism.

 Parathyroid gland – The parathyroid gland regulates calcium levels.

 Thymus – Stimulates the immune system.

 Pancreas – Secretes insulin when carbohydrates are being digested.

 Adrenal gland – Produces hormones that balance electrolytes and water in the body.

 Ovary – Female organ which produce female sex hormones and ova.

 Testes – Male organ which produce male sex hormones and spermatozoa.
 Lymphatic System
The lymph system is a network of organs, lymph nodes, lymph ducts, and lymph
vessels that make and move lymph from tissues to the bloodstream.

Lymphatic system organs and functions

 Lymph nodes – Stores lymphocytes or white blood cells.

 Spleen – Removes worn out red cells, bacteria and cell fragments from the blood

 Thymus – Generates t-cells lymphocytes

 Tonsils – Provides protection againts pathogens that enters the body.

 MODULE 3

Basic Pathlogy and Microbiology

Pathology is a branch of medical science primarily concerning the examination of
organs, tissues, and bodily fluids in order to make a diagnosis of disease.

Microbiology is the study of microorganisms, which are microscopic, unicellular, and

cell-cluster organisms.

Physiology is the branch of biology that deals with the normal functions of living
organisms and their parts.

As massage therapist you may encounter clients that have disorders, under medical
treatment, or who are taking medications. Therapist needs information regarding these
conditions to safely conduct massage sessions in these situations.

Various microorganisms are always present and could easily be transmitted that
could cause diseases. It is therefore important that the massage therapist study Microbiology
and Pathology to prevent transmission of disease from client to massage therapist and vice
versa.

Basic Terminologies
 Disease – This refers to a condition of illness that imapris bodilily functions,
associated with specific signs and symptoms.
 Carrier – An individual who is host to a pathogenic microorganism and who has the
potential to transmit the pathogen to others.
 Communicable disease – An infectious disease transmissible by direct contact with
an affected individual or the individual's discharges or by indirect means.
 Contagious disease - An infectious disease communicable by contact with one who
has it, with a bodily discharge of such a patient, or with an object touched by such a patient
or by bodily discharges.
 Microbe – A microorganism that is able to carry on living process and may or may not
cause disease.
 Pathogen – A microorganism or parasite that can cause disease.
 Endemic – A disease that exists permanently in a particular region or population.
 Epidemic – An outbreak of disease that attacks many people at about the same time
and may spread through one or several communities.
 Pandemic – When an epidemic spreads throughout the world.
 Common Microorganisms
Bacteria
 Small one-celled microorganisms of the class Schizomycetes.
 Some are round (cocci), rod-shaped (cacilli), spiral (spirochetes), or comma-shaped
(vibrios)

Virus
 A virus is a small infectious agent that replicates only inside the living cells of other
organisms.
 More than 200 viruses have been found to cause disease in humans.
 Some kinds of viruses are adenovirus, arenavirus, enterovirus, herpesvirus, and
rhinovirus.
 Self-limiting, hence development of resistance is the only treatment without further
medications.

Fungi
 A simple parasitic plant that lacks chlorophyll.
 It is unable to make its own food and depends on other life forms.
 A simple fungus reproduces by budding. Many-celled fungi reproduce by making
spores.

Protozoans
 Single-celled, tiny living things that are the lowest from of animal life.
 About 30 kinds of protozoa cause diseases in humans-protozoal, protozoan.

Parasites
 An organism living in or, obtaining nourishment from another organism.
 A facultative parasite may live on another organism but is cable of living
independently.
 An obligate parasite is one that depends entirely on another organism.

Infection Process
Infection is an invasion to the body tissue by pathogenic microorganisms, resulting in
signs and symptoms as well as an immunologic response. The patient’s immune response
may compound the tissue damage; such damage maybe localized or systemic.
 Signs and Symptoms of Inflammation
The body reacts to microbial invasion by producing inflammatory response. The
inflammatory response is controlled by chemical, cellular and vascular functions that have the
ability to adjust that response to the severity of the threat. Other manifestations include fever,
malaise, nausea, vomiting and purulent discharge from wound.

The signs and symptoms of inflammation are the following:

 Redness (rubor)
 Swelling (tumor)
 Heat (calor)
 Pain (dolor)
 Loss of function (function laesa)
 Pathology Relevant to practice of Massage Therapy
Musculoskeletal System
Condition Description
Dislocations Dislocation are
traumatic injuries to
joints in which the
articulating bones are
forcefully separated.
Fatigue Fatigue is a state of
less than optimal
performance because
the body has had
inadequate rest and
recovery time.
Fractures A fracture is any kind of
broken or cracked
bone.
Sprains Sprains are injured
ligaments.
Strains Strains are injured
muscles.
How is it recognized?
Acute dislocations are
extremely painful. The bones
may be visibly separated and
a total loss of function occurs
at the joint.
A person suffering from
mental or physical fatigue
feels tired, moves inefficiently
and may be more prone to
injury.
Most fractures are painful and
involve loss of function at the
nearest joints, but some may
be difficult to diagnose without
an X-ray.
In the acute stage, symptoms
include pain, redness, heat,
swelling and loss of joint
function. In the sub-acute
stage these symptoms will be
abated, although not entirely
absent.
Pain, stiffness and
occasionally palpable heat
and swelling will be present.
Is massage indicated or
contraindicated?
Massage is indicated in the sub-acute
stage for dislocations, as long as work is
conducted within pain tolerance.
In the absence of other contraindicated
conditions, massage is systemically
indicated for fatigue.
Massage is locally contraindicated for
acute fractures, but work done on the
rest of the body can yield reflexive
benefits. Massage is indicated for people
in later stages of recovery from fractures.
Massage is indicated for sub-acute
sprains. It can influence the healthy
development of scar tissue and reduced
swelling.
Massage is indicated for muscle strains,
to influence the production of useful scar
tissue, reduce adhesions and edema
and reestablish range of motion.
 Pathology Relevant to practice of Massage Therapy
Integumentary System
Is massage indicated or
Condition Description How is it recognized?
contraindicated?
Acne Acne is a bacterial It looks like raised inflamed Massage is locally contraindicated fro
infection of sebaceous pustules on the skin, acne because of the risk of spreading
glands usually found on sometimes with white or black infection.
the face, neck and tips.
upper back.
Burns Burns are caused by First-degree burn involves Massage is locally contraindicated for all
damage to the skin that mild inflammation. Second- burns in the acute stage.
causes the cells to die. degree burns include
It can be caused by fire, blistering and damage at
overexposure to the sun deeper levels of the
and extreme cold. epidermis. Third degree burns
penetrate the dermis itself and
will often show white or black
charred edges.
Open wounds and These include injury to A crust of scab appears at the Massage is locally contraindicated for
sores the skin that has not site of the injury. any unhealed skin injury with which
healed and vulnerable bleeding has occurred.
to infection if exposed to
bacteria or other
microorganism.
Scar Tissue Scar tissue is the Scar tissue on the skin often Massage is locally contraindicated
growth of new tissue, lacks pigmentation and hair during the acute stage of any injury in
skin or fascia after follicles. which the skin has been damaged.
injury.
 Pathology Relevant to practice of Massage Therapy
Circulatory System
Is massage indicated or
Condition Description How is it recognized?
contraindicated?
Heart Attack A heart attack or Symptoms of heart attacks Massage is contraindicated for patients
myocardial infraction include angina, shortness of recovering from heart attacks. After
(MI) is damage to the breath, feeling of grate complete recovery, heart attack patients
myocardium caused by pressure on the chest, pain may be good candidates for massage
a clot or plague around the left shoulder, arm, but not without medical clearance.
fragment getting lodge jaw and back.
somewhere in a
coronary artery,
depriving the cardiac
muscle of oxygen.
Hypertension Hypertension is the High blood pressure has no For mild high blood pressure, massage
technical term for high dependable symptoms. The may be useful to control stress. High
blood pressure. only way to identify it is by blood pressure requires medication
taking several blood pressure usually contraindicates circulatory
measurements over time. massage, but some circumstances,
massage may be appropriate with a
doctor’s approval.
Varicose veins Varicose veins are Varicose veins are ropey, Massage is locally contraindicated for
distended veins, usually slightly bluish, elevated veins extreme varicose veins and anywhere
in the legs, caused by that twists and turn out of their distal to them. Mild varicose veins
valvular in competence usual course. contraindicate deep, specific work, but
and a backup of blood are otherwise safe for massage.
returning to the heart.
Hematoma A hematoma is a deep Superficial hematomas are Massage is locally contraindicated for
bruise (leakage of simple bruises. Deep bleeds acute hematomas because of the
blood) between muscle may not be visible, but they possibility of blood clots and pain. In the
sheaths. will be painful and if extensive sub acute stage, when the surrounding
bleeding is present, the blood vessels have been sealed shut
affected tissue will have a gel- and the body is in the process of
like feel characteristic. breaking down and reabsorbing the
debris, gentle massage within pain
tolerance around the perimeter of the
area and hydrotherapy can be helpful.
 Pathology Relevant to practice of Massage Therapy
Nervous System
Is massage indicated or
Condition Description How is it recognized?
contraindicated?
Headaches Headaches are pain Tension headaches may be Massage is systematically
caused by any number bilateral and general painful. contraindicated for headache due to
of sources. Muscular Vascular headaches are often infection or CNS disturbance. Massage
tension is the most unilateral and have distinctive is indicated for tension headaches.
common source of pain; “throbbing” pain from blood
congestive headaches flow into the head. Headaches
are less common and brought about by central
headaches due to nervous system disease are
serious underlying extreme, severe and
pathology are the rarest prolonged.
of all.
Insomnia Insomnia is the inability Signs of insomnia include Massage is systematically indicated for
to attain adequate general fatigue, reduced insomnia.
amounts of sleep. mental capacity and slow
healing processes.
Seizure Disorder / Seizure disorders are Seizure disorders are Massage is contraindicated during
Epilepsy usually caused by diagnosed through CT scans seizures, but is indicated at all times.
neurological damage, and MRI, seizure may take
although it may be very different forms for
impossible to delineate different people, and they
exactly what the range from barely noticeable
damage is. Epilepsy is to life threatening.
one type of seizure
disorder.

Pathology Relevant to practice of Massage Therapy

Endocrine System
Is massage indicated or
Condition Description How is it recognized?
contraindicated?
Diabetes Mellitus Is a group of metabolic Early symptoms of diabetes Massage is indicated for people with
disorders characterized include frequent urination, diabetes as long as their tissue is
by glucose intolerance thirstiness, and increased healthy and they receive medical
or deficiency and appetite along with weight clearance.
disturbances in loss, nausea and vomiting.
carbohydrate, fat and
protein metabolism.
 Pathology Relevant to practice of Massage Therapy
Excretory System
Is massage indicated or
Condition Description How is it recognized?
contraindicated?
Kidney stones A kidney stone is a Small stones may show no Massage is contraindicated for someone
deposit of crystalline symptoms at all, but larger experiencing renal colic (a kidney stone
substances inside the stones can cause extreme attack) although it is appropriate for
kidney or the ureters. pain that may be people with a history of stones, but no
accompanied by nausea and current symptoms.
vomiting.
Urinary tract infection An infection of the Symptoms of the UTI include Circulatory massage is systematically
urinary tract, usually by pain and burning sensations contraindicated for both acute and
bacteria that live during urination. In the acute chronic renal failure.
normally and stage fever and general
harmlessly in the malaise may also be present.
digestive tract.
Renal failure Renal failure is a Symptoms of acute and Massage is systematically
situation in which the chronic renal failure differ in contraindicated for both acute and
kidneys are incapable severity and type of onset, but chronic renal failure.
of functioning at normal they have in common reduced
levels. urine output, systemic edema
and changes in mental state
brought about by the
accumulation of toxins in the
blood.
 MODULE 4

Massage Therapy Flow

The massage therapy process are divided into three phases:

1. Pre-massage – This consists of two main actives conducted prior to massage

application

1. Client Assessment – The therapist interviews the client in order to

understand the client’s needs and requests. This includes the identification of
contraindications, taking the client’s vital signs, and formulating a massage plan. Results of
the assessment are recorded in the S.O.A.P form.

2. Preparation – The therapist prepares the venue and paraphernalia for

massage while the client prepares for the massage.

2. Massage Proper – This is the application of massage techniques, in accordance with

the previously formulated massage plan.

3. Post-massage – This consist of two main activities conducted after the massage
application.

1. Aftercare – Means providing assistance to the client after the massage proper.

2. Documentation – Final completion of the S.O.A.P form, and the therapist’s

recommendation for future sessions.
 Pre-massage: Client Assessment
Client Intake Form
Before conducting an interview, prepare the client intake form with the following
information:

 Client’s Information
 Date of Initial Visit
 Additional information that will be used to help plan safe and effective massage
sessions
 Medical History
 Agreement
 Signature of the client and date accomplished
 Signature of Massage Therapist and date accomplished

After greeting the client, escort him/her to a quiet area with adequate lighting for
reading and writing.

The location of the interview is important to establish productive exchange of

information between the client and attendant. This is achieved by the atmosphere of warmth,
safety and comfort.

Wait till the client is seated and in comfortable position before asking questions. The
condition and age of the client should always be considered such as:

 Healthy client does not need a lengthy interview. It should be a maximum of 4

minutes.
 Client who undergone surgery should undergo careful and focus evaluation.
 The interview should be thorough and fast. It should be a maximum of 10 minutes.

Write the client’s answers in the client intake form. Ask the client to sign the form and
the date accomplished. Then sign the form and the date accomplished
 Pre-massage: Client Assessment
SOAP
Subjective, Objective, Assessment and Plan (SOAP) is a method of documentation
used by massage therapists to write out notes in a clients’ chart.

The SOAP Form must contain the client information and the four components.

The Therapist should always sign the form and the date accomplished.

Four components of SOAP form:

1. S (SUBJECTIVE) - It is the client’s report of how he or she has been doing since the
last visit. Should indicate the client’s complaints, if any. It includes the following information:

1. Symptoms (client’s complaints):

2. Location

3. Intensity

4. Frequency

5. Duration

6. Onset

2. O (OBJECTIVE) - The objective component is straightforward and includes the

following:

1. Vital Signs

2. Visual

3. Sensory

4. Palpation

5. Range of Motion

3. A (ASSESSMENT) - The therapist gathers the information from the Subjective and
Objective Information. The long term and short term goals should also be indicated.

4. P (PLAN) - This includes what type of treatment will be given such as:

1. Future Treatment

2. Frequency
 Pre-massage: Client Assessment
Vital Signs
A massage therapist must conduct assessment before recommending what type of
therapeutic massage service to be conducted. All the information gathered during the physical
assessment is written in the SOAP form.

Purpose:
 To observe the general condition of the client.
 To serve as a guide in meeting the needs of the client.
 To aid the massge therapist in planning the client’s massage program.
 To prevent possible injury and complication to the client.

Blood Pressure
The following are the steps on how to get the blood pressure of the client:

1. Gather the necessary equipment.

2. Position the client comfortably on chair with arms rested alongside his body.
3. Look for clients radial artery and palpate for the palpatory pulse.
4. Position the cuff two inches above the antecubital fossa. Inflating bladder directly over
brachial artery ensures that proper pressure is applied during inflation.
5. Position the sphygmomanometer so that the measuring scan is turned away from the
client’s line of vision and the mercury column vertical.
6. Place the stethoscope disc over the brachial artery to ensure good amplification of
sounds for accurate reading. Each earpiece should follow angle of ear canal to facilitate
hearing.
7. With the stethoscope in position, inflate the cuff until the mercury rises to
approximately 20 – 30 mm. above the anticipated systolic pressure.
8. Release the air in the cuff slowly while noting the reading on the manometer.
9. Note the first clear and strong sound as the systolic reading and the last audible
sound as the diastolic reading.

Respiratory Rate
The following are the steps on how to get the respiratory rate of the client:

1. Note the rise and fall of the patient’s chest with each inspiration and expiration.
Observation can be made without disturbing the client’s bed clothes.
2. Using a watch with a second hand count the number of respiration for one minute. If
the respiration is abnormal repeat the count in order to determine accurately the rate and
characteristics.

Pulse Rate
The following are the steps on how to get the pulse rate of the client:

1. Press client’s wrist with the thumb at the back of the wrist and the first two fingers
over the radial artery with moderate pressure.
2. Count for the number of pulsation for one full minute.
3. Observe for the rise and fall of the client’s chest while fingers are still on the client’s
radial artery after counting the pulse rate.
4. Inform the client about the results and its significance.

Temperature
The following are the steps on how to get the temperature of the client:

1. Clean the thermometer with antiseptic solution, from the valve towards the stem in a
circular motion.
2. Turn on the digital thermometer.
3. Place the thermometer to the client's axilla.
4. Hold the thermometer in place in 2 to 3 minutes or until you hear the beep sound.
5. Remove the thermometer from client's axilla and note the reading.
6. Inform the client about the results and its significance.
7. Disinfect the thermometer with an antiseptic solution from the stem going towards the
valve in a circular motion.

Pre-massage: Client Assessment

Visual Assessment
Visual assessment is done to evaluate conditions / abnormalities of the area.

Purpose:
 To provide information regarding the conditions of the soft tissues fo any variations of
skin color.
 To observe the differences in bilateral symmetry of tissues.
 To check for any kind of marks or wound on the skin.

The following are the steps on how to conduct visual assessment:

1. Identify the differences in color (areas of redness or paleness)

2. Identify the marks, bruises, moles, wounds and scars
3. Identify the symmetry of soft tissues
4. Write all findings in SOAP form

Pre-massage: Client Assessment

Palpation
Palpation assessment is done to evaluate different temperature, textures and
movement of the soft tissues.

Purpose:
 Locate the target muscle that is being palpated and assess its health by feeling for its
tone and texture.

Possible problem that may be encountered:

 Fever - Clients with fever should deny massage

 Inflammatory - Need to know how long the pain and discomfort have been present.
An acute injury that has existed less than 72 hours is local contraindications to massage
but general massage will help the rest of the body relax.

The following are the steps on how to conduct palpation:

1. Place the client in a comfortable position.
2. Expose & Palpate the affected area.
3. Note for any changes in skin temperature.
4. Look for any soft tissue restricted fascia, trigger points and tissue ederma/ swelling.
5. Note for skin flexibility / movement.
6. Write all findings in SOAP form.

Pre-massage: Client Assessment

Sensory Assessment
Sensory assessment is done to evaluate the severity of pain.

Purpose:
 To gather information regarding the conditions, and pain tolerance of the client.
 To assess the client’s pain through a pain scale.

Possible problem that may be encountered:

 Unidentifiable pain - Refer to the healthcare professionals

 Uncooperative client - Refer to the healthcare professionals

 Acute pain - Cold Compress

 Chronic pain - Hot compress, contrast bath, massage

The following are the steps on how to conduct sensory assessment:

1. Place the client in a comfortable position.

2. Ask the affected area.
3. Ask if the condition is acute or chronic.
4. Ask if the pattern of pain are constant, intermittent or others.
5. Ask if what causes the pain to increase.
6. Observe if the pain occurs upon movement or in resting position.
7. Ask the intensity of pain 0 to 10 scale.

o0 no pain

o2-3 mild pain

o4-5 moderate pain

o6-7 severe pain

o8-9 maximum pain

o10 seek healthcare professionals

8. Write all findings in SOAP form.

 Pre-massage: Client Assessment
Range of Motion
Purpose:
 To gather information regarding the conditions, and pain tolerance of the client.
 To assess the client’s pain through a pain scale.

Types:
 Active Range of Motion – Limb is actively moved; with no muscle contraction.
 Passive Range of Motion – Lim is passively move with the help of massage therapist;
no muscle contraction.

Procedure:
1. Assess only the affected area / joints.
2. Place the client in a comfortable position
3. Let the client move (active) or help the client move (passive) the affected area.
4. Note for any restriction in movement.
5. Write all the findings in SOAP form

Basic Stroke: Effleurage

The term Effleurage comes from the French word effleurer, which means to flow or
glide. The application of unbroken gliding movement that are repeated and followed the
contour of the client’s body. These movements maybe linear or circular. The stroke maybe
applied by the therapist hands using palms, fists, thumbs, fingertips or forearms. The
pressure maybe superficial (gentle) or deep.

It is used to introduce touch and for applying lubricant and excellent for assessing
and exploring surface and underlying tissues. It is also the stroke used to begin and end a
massage because it is so proficient at moving blood and lymph. It can be used to prepare
tissue for deeper massage and to flush out the tissue after using other strokes and on virtually
every type of body surface, making it the preferred transition stroke to use between other
strokes.

Purposes / Benefits:
 Warm bodily tissues, making them more extensible.
 Relax the client and prepare an area for deeper strokes.
 Soothe an area after deep work.
 Soothe places too painful for deep work.
 Calm the nervous system when done slowly.
 Stimulate the nervous system when done quickly.
 Aid in the moving of wastes out of congested areas (also known as flushing).
 Create length in a muscle, if applied with fiber direction.
 Increase blood and lymph circulation.
 Soothe tired, achy muscles.
 Relieve insomnia.

Techniques/ Variations
 One-Handed - This variation implies that one hand or one thumb is used to apply
gliding pressure and is used for small areas such as in between the metacarpals or
metatarsals.

Sub-variations:


oRaking – To use the raking technique, the fingers should be together or apart moving in one
direction. The purpose of this is to check the proper alignment.

oIroning (using forearms / knuckles) – A deep one-handed effleurage often done with the
forearm, knuckle, fist or palm of the hand. The deeper the glide the slower the move. This
technique calms the nervous system when done slowly.

oCircular – It can be performed around the shoulder, hip, knee and abdomen. It relaxes the
client and prepares an area for deeper stroke.

 Two-Handed - This variation works well up or down the back in a heart shape or
heart effleurage, up the leg, or up the arm.

Sub-variations:


o Heart – Performed up and down for the back in a heart shape up the leg or
up the arm. It increases blood and lymph circulation and relaxes the client.

o Circular – One hand may be placed next to or on top of the other hand. This
technique relieves insomnia.

 Alternate hand - To perform alternate hand effleurage, glide on hand or thumb

across the skin, lifting it up as the other hand or thumb follows behind in succession. The
sequence resembles a paddlewheel.

Sub-variations:


oRaking – The index and middle finger forming the letter V may be placed on either side of the
spine. It is used to move from one side of the table to the other without losing contact with
the client.

oCircular/ Sun Moon – It can be performed as one-hand circles a region and the other hand
move behind the first hand in a half circle or a crescent shape.

 Nerve stroke - It is considered as light effleurage, feather-light like finger tracing over
the skin used as a finishing stroke in massage therapy and is typically done at the end of
massaging a body segment and at the completion of the massage.

Avoid pressure that is too light because it may be perceived as ticklish or produce
goose bumps.


The direction of nerve stroke is superior to inferior or proximal to distal because
downward movements are more relaxing.


Basic Stroke: Petrissage / Kneading

It comes from the French word petrir meaning to mash or to knead. It typically follows
effleurage strokes. It consists of cycle of rhythmic lifting, squeezing, and releasing of tissue.

It is the stroke of choice to “milk” the tissue of metabolic wastes and draw new blood
and oxygen into the tissues. It stretches and broadens the tissue. Grasp the skin or muscle
with the hand in a C formation. Lift up the skin and the underlying muscle tissue and firmly
knead, wring, or squeeze. Focus is on lifting the tissue and moving it vertically or horizontally
rather than just pinching it. The pressure should be applied in a rhythmic circular pattern to
achieve alternate compression and relaxation of the muscle.

Purposes / Benefits:
 Increasing blood flow.
 Working out metabolic wastes.
 Reducing local swelling.
 Relieving general fatigue.
 Improving cellular nutrition.
 Mechanically relaxes and lengthens the muscle.
 Addressing tension under the surface.
 Reducing muscle soreness and stiffness.
 Stimulating the nervous system.
 Softening superficial fascia.
 Producing analgesia by stimulating the release of pain-relieving substances such as
endorphins.

Techniques/ Variations
 One-Handed - The entire hand or the pads of the fingers and thumb can be used to
lift the tissue. This variation is well suited for smaller muscular areas, such as the arms, top
of the trapezius, or the arms and legs of a child. Both hands are lifting, compressing, and
releasing the tissue simultaneously. It is often used to address larger muscular areas such
as the back.

 Two-Handed - The technique used for this is the same as one-handed petrissage
except both hands are lifting, compressing, and releasing the tissue simultaneously.

Sub-variations:


oPraying hands – Fingers are interlaced in a praying hand position. It helps maintain proper
position.

oOcean Waves – Use a back and forth movement while the hand opposes each other, lifting
the sides and pressing down while on top. It is typically applied across a larger muscular
area or horizontally down the back.

 Alternate hand - Lift the skin and underlying tissue with one hand and compress.
Next is lightens the grip enough to allow the muscle tissue to be released while still
remaining in contact with the skin. Repeat the first move with the opposite hand. Do not
 lose contact with the skin while switching hands. It is done to stimulate the nervous system
and improve cellular nutrition

 Fulling - Grasp the tissue with both hands; lift it up and away from the bone while
spreading it out laterally. Repeat the movements until the tissues feel warm and elastic. It is
effective for broadening muscles and their related tissues and mimics the movement of a
muscle when it contracts (broadening).

 Skin rolling - Involves lifting and compressing the skin and superficial fascia. It is the
technique essential to Bindegewebsmassage (connective tissue massage) and myofascial
release. It is one of the few massage techniques that may be applied over bony areas.
Grasp and lift the skin between the fingers and thumbs compressing the tissue. Roll the
skin as though you’re rolling a pencil using your fingers to scoop up the skin as you move
across the area.

Basic Stroke: Friction / Rubbing

Friction comes from the Latin word friction, meaning to rub. It typically follows
petrissage in the sequential order of massage strokes. It is performed by compressing tissues
in several directions and typically done dry, using little or no lubricant. It is often used for
areas that have little or no blood supply, such as ligament and tendons. It is also used to
address large areas such as the back or the arm.

The stroke is well suited for areas that lack muscle bulk such as the ankle, the sides
of the head, or the suboccipital region. It may be applied with the palm of one or two hands, or
specific work may be done with the tip of the thumb, fingers, or elbow. It is delivered
superficially by sliding the therapist’s hands, palms, finger, or knuckles back and forth over the
client’s skin or to deeper tissue layers.

Purposes / Benefits:
 Generating heat.
 Dilating the capillaries.
 Increasing circulation.
 Promoting venous blood flow.
 Loosening stiffness in joints.
 Relaxes muscles.
 Improving the glandular action of the skin.
 Promoting proper scar formation by reorganizing collagen, creating a more
biofunctional pattern.
 Breaking down and freeing adhesions.
 Mimicking muscle broadening and stretching that occurs in normal muscle
movement.
 Reducing trigger and tender point formation/activity.

Techniques/ Variations
 Superficial Warming - Also known as Heat Rub. It generates heat by creating
resistance to motion. Place both hands palm down on the client skin. The fingers of each
hand should be together firmly. Move the hands briskly and simultaneously in opposite
directions, one hand moving towards you and the other moving away from you. The hands
should pass each other in mid stroke and continue to alternate. Begin to pick up speed to
build resistance. The muscles of the shoulder and upper arm are used to propel the hands,
 reducing the stress on the therapist’s hands. May also be done with a towel, rubbing it
quickly on the client’s skin.

Sub-variations:


oSawing – Fingertips, knuckles, or ulnar surface of one or both hands may be used if the
surface area treated is small. Compress the tissue firmly with open palms and extended
fingers of both hands. It is best suited for the extremities.

 Rolling - Roll the skin, muscle, and surrounding tissues around the bone, moving
both hands in opposite directions. As you roll the tissue around extremity, use a back and
forth movements while you compress the tissue and slide your hands from distal to
proximal.

 Wringing - While compressing the lubricated tissue on all sides with palmar surfaces
of the hands and fingers, move the hands in opposing directions. Slide the hands toward
the trunk of the body during the massage movement (distal to proximal). Wringing friction is
performed vigorously, like wringing water out of a cloth. The movement is best suited for
arms, legs and fingers.

 Cross fiber - It is also known as Deep Transverse Friction. It is a very precise and
penetrating form of friction. The direction of movement should be across and perpendicular
to the pattern of muscle fibers. One or more fingers are placed on the skin at the exact site
of a pain or injury. Apply firm, consistent pressure in one or both directions, move the
fingers in a back and forth motion.

 Chucking - It is also known as Parallel Friction. It refers to deep friction applied in the
same direction in muscle tendons or ligamentous fiber. It uses the thumbs or fingers to rub
back and forth moving the superficial tissue over the underlying structure. It is usually
performed one handed, while the other hand is supporting the limb that is being massaged.
This movement is often applied between bony areas.

 Circular Friction - It uses small circular movement that glides superficial tissue layer
over underlying tissue layer in different direction using the fingers or palms of the hand.
Particularly useful around the joints and in bony areas.

Basic Stroke: Tapotement / Percussion

The word Tapotement is a French derivation of an Old French term taper that means
a light blow, which in turn was derived from Anglo-Saxon term taeppa, meaning to tap, in the
sense of draining fluid from a cavity.

It involves repetitive staccato striking movements of the hands, moving either

simultaneously or alternately. May be delivered with the ulnar surface of the hand, tips of the
fingers, open palm, cupped palm, or back or ulnar surface of a loosely closed fist. It is use to
finish an area or end the massage. Avoid the application immediately after exercise because
this stroke can activate muscle spindles and stimulate cramping.

Heavy tapotement over the kidneys in the low back area is not advised because they
are not adequately protected by bodily tissue. May be applied directly to the skin or through
 the drape. Begin with light pressure and moderate strike speed, gradually increase speed,
and finally diminish speed and depth. It is delivered rhythmically, allowing your hands to
spring back after contact.

Purposes / Benefits:
 Stimulate nerve endings initially, becoming more sedative if continued.
 Aid in decongesting the lungs by loosening and mobilizing phlegm in the respiratory
tract.
 Tone atrophied muscles.
 Increase local blood flow.
 Access deeper structures such as hip rotators.
 Create an ultrasound effect manually.
 Desensitize a hypersensitive area after a few minutes of tapotement stimulation.

Techniques/ Variations
 Tapping - Using your fingertips of one or both hands strike the body’s surface. It
increases local blood flow.

Sub-variations:


oPunctuation – Using your fingertips of one or both hands, strike the body’s surface rapid, but
consistent delivery of pressure and speed. A hard version of tapping punctuation
tapotement is excellent for the soles of the feet.

oPulsing – It is performed one handed, with an alternate deep and light tap. The deep tap is
comparable to a full note, and the light tap is comparable to a half note.

oRaindrops – Commonly used on the face or scalp. Feels like light rain - each fingertips of the
hand strikes the skin lightly at a different time.

 Pincement - Also known as plucking, done the same as the skin rolling technique.
The skin is grasped using a quickly delivered striking motion, lifted, and released while the
fingers of the opposite hand follow suit.

 Hacking - Also known as Karate Chop. Produces a slight vibratory action coupled
with the percussive action. Hacking along muscle fibers with fingers parallel, produces
relaxation in muscles. It is applied across large muscles, with the fingers perpendicular,
stimulates muscle spindle activity. Minute contractions of the muscles are the result.

Sub-variations:


o Quacking – Places the palms of both hands together. The skin is struck
using only the sides of the third, fourth, and fifth finger. The air moving out of the hands
during the strike make a quacking sound.

 Cupping - Curve the palmar surface of the hand into a cup, as if holding water. Strike
the client’s skin with the edge of a cupped hand, making a muffled horse-hoof sound. A
vacuum is created when lifting the palm from the skin’s surface, hence, the hollow sound of
suction. This is the stroke of choice for loosening mucus and phlegm in the chest cavity. it
is very vigorous stoke and may induce coughing.

 Pounding - It is performed with the sides of one or both loose fists contacting the
skin alternately. Loose fist beating is used on large, muscular areas such as the posterior
legs and the hips.
 Sub-variations:


oRapping – Performed using a loose fist placed palm down striking the skin’s surface like the
therapist knocking on a door.

 Diffused - It is commonly used over the abdominal region. Drag the open hand
across the skin, as you move across the skin’s surface.

 Clapping - Also known as Slapping. It is performed with the palmer surface of the
hands and finger striking the skin with alternate strokes. The fingers are held together. A
loud smacking sound is heard if done correctly. A light upward slapping may be done on the
sides of the face. It is not recommended for use on clients who are known to be survivors
of abuse as it may trigger painful past episodes of abuse.

Basic Stroke: Vibration

Vibration comes from the Latin term for a shaker. It is rapid shaking, quivering,
trembling, or rocking movements applied with the fingertips, full hand, or an appliance.

Purposes / Benefits:
 Enhances general relaxation.
 Increases circulation.
 Stimulates muscle spindles, thus creating minute muscle contractions.
 Relieves upper respiratory tract congestion, including sinus congestion.
 Stimulates peristalsis of the large intestine.
 Moves gas in the lower gastrointestinal tract.
 Stimulates synovial fluid production in joints when applied with traction.
 Reduces trigger and tender point’s activity

Techniques/ Variations
 Fine - Place fingertips on the skin and begin a trembling movement by rapidly
contracting and relaxing the arm keeping the fingers and wrist stiff. Fingers should be
moving from side to side while maintaining contact with the skin. The therapist’s hand may
remain in one location or glide down or around an area, such as the back, legs, or arms,
while applying quivering movement.

Another way to apply fine vibration is to compress and lift the tissue into your hands.
The stroke feels as if you are slurping up the tissue in your hands.


Once this is done, begin trembling the hand that is in direct contact with the tissue.
This type of vibration is especially useful over the abdomen to increase peristalsis, stimulating
digestion and elimination.

 Jostling - It also known as Coarse. It can be used on a muscle belly or limb. When
applying it to muscle, grasp the muscle belly or bellies and shake vigorously, but
rhythmically, back and forth. This may feels like rolling friction. Shortening the muscle by
moving the attachment closer together create slack in the muscle before applying vibration.
If applied to a limb, use one or both hands to grab the limb securely. The most proximal
 joint is preferred. Add a small degree of traction by leaning back, shaking the limb. Coarse
vibration can loosen up muscles surrounding a joint and is the principle stroke used in the
Trager technique.

 Rocking - It is done by pushing the client’s body with one hand or tossing the body
back and forth on the table between two hands. It requires a pitch-and-catch motion. Push,
or “pitch”, the body with one or both hands, retrieving, or “catching” it, as the body swings
back toward you. Pitch and catch the body until it begins to move easily or finely. You can
also pitch and catch the body using one hand on each side of the body.

 Coarse Vibration - The therapist grasps the muscle or limb with one or both hands
and shakes or pulls it vigorously.

Post Massage: Aftercare and Documentation

Aftercare is the assistance provided at the end of the massage session. It should be
tailored to each individual’s situation. Recommendations for self-care is necessary to
achieved best results of the massage session

Documentation is used to create and maintain a patient’s record and develop initial
and session-to-session treatment plans as well as for comunication between healthcare
professionals. Documentation is a guidline for sate and effective treatment and proof of the
clients progress.

Characteristic of a good medical record:

 Acurate
 Complete
 Legible

Module 4: Plan and Implement Massage Session

mM
MODULE 5
Swedish Massage
It is scientific treatment by certain passive, systematic manipulation upon the nude
skin of the human body, with the object of promoting and maintaining balance circulation.

Benefits of Swedish massage

 Relaxation – it is the refreshment of body and mind.
 Treatment – application to a patron for disease or injury.
 Aesthetic – preserving beauty
 Hygienic – tending to promote or preserve health.
 Remedial – tending to restore health.

Contraindications
 Haemorrhages – may inflict more damage to the blood vessels, tend to lose more
blood (example: menstruation).
 Infection – to avoid the spread of pathogens.
 Malignancy – example: cancer, ectopic.
 Fracture – to avoid additional injury.
 Burns – can inflict or cause additional pain and injury.
 Contagious skin disease – example: warts and impetigo (characterized by blisters
that form yellow-brown scabs).

Endangerment Site
During the massage, deep sustained pressure should not be performed on areas
where nerves and blood vessels surface to the skin, and are not well protected by muscles
and connective tissues. The following are the areas to be avoided:

 Anterior Triangle of the Neck – front part of the neck which includes the parathyroid
and thyroid glands.

o Thyroid glands – found below the larynx. Secretes three (3) hormones the
Thyroxin and triiodothyronine that act on all body cells increasing the metabolic rate and
the pace of cell division. Calcitonin decreases level of calcium in the blood reducing the
rate at which the bone is broken down.

o Parathyroid gland – found posterior embedded in the thyroid gland. Four (4)
tiny parathyroid glands secrete the parathyroid hormones (PTH) which has opposite effect
to calcitonin because it increases the level of calcium in the blood by stimulating bone
breakdown.

 Posterior Triangle of the Neck – also called the Nape and the parts include cervical
vertebrae

 Anterior in the Throat

oJugularVein – the jugular veins are in the neck and drain blood from the head, brain, face and
neck and convey it toward the heart.

oVagus Nerve – a remarkable nerve that supplies nerve fibers to the pharynx (throat), larynx
(voice box), trachea (windpipe), lungs, heart, esophagus and intestinal tract as far as the
transverse portion of the colon. The vagus nerve also brings sensory information back to
the brain from the ear, tongue, pharynx and larynx.

 Areas of the Suprasternal Notch – It is a small notch at the top of the sternum. It
can be seen by seeking the hollow at the base of the throat

 Axilla – lymph drainage is found, veins and arteries

 Sternum – is a long flat bony plate shaped like a capital “T” located anteriorly to the
heart in the center of the chest.
 Spinal Column – a series of contiguous or interconnecting bony or cartilaginous
segments that surround and protect the spinal cord. Also known as the backbone.

 Sciatic Notch - affecting the back of the human hip and lower limbs.

 Sciatic Nerve – It begins in the lower back and runs through the buttocks and down
the lower limb. It is the longest and widest single nerve in the human body going from the
top of the leg to the foot on the posterior aspect.

 Umbilical Area – descending and abdominal aorta.

 Twelfth Rib – dorsal body (kidney) where the kidney has no protective area.

 Inguinal angle – femoral artery, saphenous vein.

 Popliteal Fossa – veins and artery.

 Varicose Veins – carries unoxygenated blood, swollen and knotted especially found
in the legs as a result of flaws in the valves of the affected veins.

 Antecubital Fossa – a triangular cavity of the elbow that contains a tendon of the
biceps, the median nerve and the brachial artery.

 Lateral and Medial Epicondyle – rounded articular areas in the joints.

Handwashing
To control infection, wash and dry hands thoroughly before and after the massage
therapy or after using the toilet. The following are the recommended hand washing
procedure:

1. Turn on the faucet

2. Wet hands, forearms and elbows.
3. Use liquid soap and apply to the hands up to forearms in a circular motion. In
washing, include the areas in between fingers. (Liquid soap is preferred over bar soap
because bar soap becomes contaminated after use). Wash for 15 seconds. Use nail
brush to clean underneath your nails. If there is a broken skin, extend the washing up to 2
minutes.
4. Rinse the hands and forearms thoroughly.
5. Use clean paper towel in drying the hands and forearms. Use the same paper towel
to turn off the faucet.
6. Discard the paper towel.
7. When hand washing is not convenient or possible, use a high alcohol content gel /
hand sanitizer .
 Warm up
The following are the warm up exercises in preparation for the massage session:

1. Rub your palms and fingers together creating friction and warmth.
2. Put your both hands on the stomach and inhale/exhale for nine (9) times. Do not
remove both hands on the stomach.
3. Breath in and Breath out nine (9) times.
4. Shake your hands and fingers at the wrist. Do not perform this movement vigorously.
Do this for nine (9) times.
5. Roll your shoulders forward for nine (9) repetitions.
6. Reverse the direction and rotate your shoulders backward for nine (9) repetitions.
7. Circle wrist in one direction for nine (9) rotations and then reverse the direction for
nine (9) rotations.
8. Press your finger pads together as you keep your wrist apart away from your body.
9. Keep your fingers spread apart.
10. Close your eyes and count from nine (9) to one (1) as you meditate.
11. To do the reach and pull exercise.

1. Start with your open palms at your sides.

2. Pull your hands up to chest high closing your palms into fists.

3. Without stopping, continue the upward towards your hands over your head
stretching your finger tips out and inhaling simultaneously.

4. Reverse the direction bringing your arms back down.

5. Close your hands as you pass your chest and reopen them as you reach
your side exhaling forcefully.

6. Keep your pace slow and your movements graceful.

7. Repeat the sequence five (5) times.

8. Stop immediately when you become lightheaded.

Client Positioning
Supine
 In the supine position, the person is lying horizontally on the back.
 Place bolster under the client’s ankles.
 Cover the eyes using clean linen.
 Be sure the neck is not flexed.

Prone
 Assist the client to the massage bed.
 Tell the client to lie face down in a horizontal position.
 The most supported areas in this position are anterior ankles and the face.
 Use a face rest frame and cushion to keep your client’s neck straight while lying
prone.

Draping
The process of using linens to keep a client covered while performing the massage.
The following are the methods use for draping:

Towel Draping
One (1) towel is use for male client and two (2) towels for female client with the sheet
drape over the table. When using the towel, fold the towel back or under to reveal the area to
be massage.

 Accessing the abdominal area on female clients – fold the bottom towel down and
upper towel up to reveal the abdomen. The folded towel acts as the bikini top.

Sheet Draping
Two (2) sheets are required for each client, one for the table and one for the client.
As you undrape specific part of the body of the client, tuck the end of the fabric underneath
the client’s body. Untuck the sheet and re-drape when moving different areas for massage.
The preferred sheet material is flannel because it is thick and heavy and will stay on place. It
not advisable to lift, fluff or remove a sheet in such a way that will make the fabric leaves the
client’s body.

 Accessing the abdominal area on female clients – it requires the use of the towel and
pillowcase. A towel is drape on top of the sheet across the breast and perpendicular to the
body. The sheet is pulled down while the top drape remains covering the breast acting as a
bikini top. Remember to make sure the knees are flexed while working on the abdomen.
Place a bolster behind the knees and under the neck.

 Turning client supine to prone – with the client on the supine position, grasp the sheet
along the opposite edge of the table while anchoring the sheet with your thighs on the side
of the table. Instruct the client to lie face down.

Full Body Massage: Prone Position - Trunk

Prone Position
 Assist the client to position on the massage table in prone position or lying
horizontally on the massage table face down.
 Ask the client to remove his clothes. To do this properly, use a towel to prevent the
client from being exposed.
 Cover the lower body of the client using the towel you are holding.
 Place the bolster under the shin (front of the legs).
 Then put another towel to cover the upper body.

 Sanitize. Apply alcohol or hand sanitizer on your hands and forearms before starting
the massage.
 Stretching. Perform stretching on the client’s body.
 Undraping the back. Pull the towel on the upper body down to the lower body,
exposing the back of the client.
 Applying lubricant. Apply lubricant (oil) on your hands.

Perform each of the following massage techniques for three (3) repetitions:

 Heart (Effleurage)
 Two-Handed Effleurage (using knuckles)
 Two-Handed Circular (Effleurage)
 Chucking (Friction)
 Fulling (Petrissage)
 Wringing (Friction)
 Ocean Waves (Petrissage)
 One-Handed Ironing
 Two-Handed Ironing
 Cross-Fiber (Friction)
 Skin Rolling (Petrissage)
 One-Handed Raking
 Superficial Warming
 Sawing (Friction)
 One-Handed Circular
 Heart (Effleurage)
 Alternate Hand (Petrissage)
 Heart (Effleurage)

Full Body Massage: Prone Position - Head and Neck

Perform each of the following massage techniques for three (3) repetitions:

 Two-Handed Circular
 Two-Handed Effleurage (using knuckles)
 Thumb (Effleurage)
 Alternate Hand (Petrissage)
 Heart (Effleurage)

Full Body Massage: Prone Position - Lower

Extremites
Perform each of the following massage techniques for three (3) repetitions:

 Heart (Effleurage)
 One Handed Petrissage
 Chucking (Friction)
 Alternate Hand (Petrissage)
 One-Handed Effleurage (using knuckles)
 Two-Handed Effleurage (using knuckles)
 Heart Effleurage
 One-Handed Ironing
 Alternate Hand Effleurage
 Wringing (Friction)
 Fulling (Petrissage)
 Praying Hands (Petrissage)
 One-Handed Circular (Effleurage)
 Chucking (Friction)
 Fulling (Petrissage)
 Jostling (Vibration)
 Punctuation (Tapotement)
 Heart Effleurage

Full Body Massage: Supine Position - Head

Ask the client to turn from prone to supine position.

Perform each of the following massage techniques for three (3) repetitions:

 Fulling (Petrissage)
 Circular (Effleurage)
 Effleurage (using fingertips)
 One-Handed Circular (Effleurage)
 One-Handed (Effleurage)
 Raindrops
 Slapping
 Superficial Warming

Full Body Massage: Supine Position - Upper

Extremities
Perform each of the following massage techniques for three (3) repetitions:

 Heart Effleurage
 Chucking (Friction)
 One-Handed (Petrissage)
 Heart Effleurage
 Wringing (Friction)
 Praying Hands (Petrissage)
 Chucking (Friction)
 Fulling (Petrissage)
 Chucking (Friction)
 Jostling (Vibration)
 Heart Effleurage

Full Body Massage: Supine Position - Trunk

Perform each of the following massage techniques for three (3) repetitions:

 Circular Effleurage (follows small intestine to large intestine)

 Fulling (Petrissage)
 Ocean Waves
 Diffused
 Fine (Vibration)

Full Body Massage: Supine Position - Lower

Extremities
Perform each of the following massage techniques for three (3) repetitions:

 Heart Effleurage
 Chucking
 Wringing
 One-Handed Circular
 Heart Effleurage
 Praying Hands (Petrissage)
 Wringing
 Chucking
 Fulling
 One-Handed Circular
 Pulling the Fingers
 Effleurage
 Friction
 Clapping (Slapping)
 Heart Effleurage
Post Massage